WASHINGTON, D.C. — While GOP members of the U.S. House applauded a narrow approval of health care legislation late last week, party colleagues in the Senate vowed to rewrite the American Health Care Act (AHCA) more to their liking.

 

Whether both chambers end up reconciling the different pieces of legislation now is the big question in the nation’s capital. Senate Majority Leader Mitch McConnell, a Kentucky Republican, said Saturday in Louisville that he is not setting any timetable on when the chamber will produce its legislation. Nor would he indicate how closely any Senate bill would resemble what the House approved.

 

“We have some work to do but our goal is to finish the job voters across the country asked us to do, and that was to repeal and replace Obamacare (officially the Affordable Care Act, or ACA),” he said.

 

Under House legislation passed Thursday on a 217-213 vote – with a minimum of 216 needed to pass – the mandate to have health insurance or face a tax penalty would be eliminated. People who don’t have coverage through their jobs, including those who are self-employed, would be allowed refundable tax credits that would increase as they get older.

 

Those credits start at $2,000 a year for people under 30 and gradually increase to $4,000 for people 60 and older, which is significantly less than the amounts older people receive under 2010 ACA legislation. That point, along with the later amendment to the House bill that gives states the right to seek waivers that allow insurance companies to reduce the types of services covered, is what has several GOP members in the Senate concerned the House measure may unfairly hit the elderly more than anyone else.

 

“Don’t expect that what (the House passed) is game, set and match on the issue,” Rep. Steve Womack (R-Ark.) told The Wall Street Journal. He suspects that whatever the Senate may pass, “I’m guessing it will be a pretty heavy lift” for the House to approve something similar. Complicating matters in the Senate are procedural rules that limit what the chamber can pass with a simple majority, versus a 60-vote threshold; the GOP has 52 votes in the Senate. McConnell said he will try to shepherd through a bill based on “budget reconciliation” rules, which would require only a simple majority of 51 votes.

 

But two of the elements of the House bill that would require 60 votes for approval include the ability of states to opt out of regulations defining what health care services insurers must cover – such as maternity care – and a provision banning them from discriminating against people based on their health, or preexisting conditions.

 

What also could complicate Senate passage of any measure is future analysis by the nonpartisan Congressional Budget Office (CBO), which did not weigh in on the latest House legislation but did rate it before amendments were added last week.

 

That report indicated about 14 million fewer people will have insurance in 2018, the first year the AHCA would take effect, and that some 24 million fewer would have insurance by 2026. The CBO also predicted insurance premiums would rise 10-15 percent each in 2018 and 2019, and then begin to stabilize and even dip a bit from 2020 onward.

The House bill restructures how the federal government funds Medicaid, which was expanded in 31 states under the ACA, including Illinois and Ohio. Instead of matching federal dollars, states would receive annual block grants based on their populations, significantly less than what states are receiving now. Based on that change, the federal deficit would be reduced by about $340 billion by 2026 under the AHCA.

 

Governors John Kasich of Ohio and  Bruce Rauner of Illinois, both Republicans, strongly oppose the House measure. Rauner said, “Recent changes did not address fundamental concerns about the bill’s impact on the 650,000 individuals that are part of our Medicaid expansion population, nor have those changes eased the concerns of the 350,000 people in the individual market who are dealing with skyrocketing premiums and fewer choices.

 

“We will continue to voice our concerns as the law moves to the Senate. The Affordable Care Act is a seriously flawed law that should be changed. Difficult as the task has proven, we are hopeful that our federal lawmakers will continue to work hard to get this right for the people of Illinois and our nation.”

 

The National Farmers Union (NFU) also blasted the House measure, while saying it recognizes some changes need to be made to health care policy overall. NFU President Randy Johnson said, “The bill would still cap Medicaid, disproportionately affecting rural Americans who enroll in Medicaid at higher rates, and whose hospitals rely more on the program than their urban counterparts. The bill would also base subsidies on a person’s age, adversely affecting younger farmers.

“House leadership has made the legislation worse by providing even fewer protections for family farmers and rural Americans. The recent … amendment allows states to apply for waivers for several of the law’s crucial underpinnings. This would be particularly detrimental to individuals with preexisting conditions. NFU’s priority for any bill is that it offers coverage for more people, rather than fewer.”